Weaver Elementary PTA Reimbursement or Check Request Form

Instructions:

1. Fill out completely with the description of reimbursement and breakdown of expenses by budget category (missing info will delay payment).

2. Attach copies of all receipts.
3. Specify if the check should be placed in office file folder or mailed to yourself/vendor.
4. A receipt of your submitted request will be emailed to you (to keep for your records).

Questions: weavertreasurer@yahoo.com

Item Description Price Qty

Reimbursement Information

Select Type:*

Check Payable To:

Should check be placed in the folder or mail to vendor?

If check is to be mailed, provide the address.

EVENT/COMMITEE/DEPARTMENT for Expenses- Submit separate forms for each committee/dept.*

Other(please list budget line)

EXPENSES for REIMBURSEMENT

How many items(expenses) are you listing for this Event
Every event/department needs a separate reimbursement form to be submitted Do not combine expenses from multiple committees/dept/events. $0.00

#1	$Expense Amount$ Expense Description Vendor/Store Name for Expense	copy
#2	$Expense Amount$ Expense Description Vendor/Store Name for Expense
#3	$Expense Amount$ Expense Description Vendor/Store Name for Expense
#4	$Expense Amount$ Expense Description Vendor/Store Name for Expense
#5	$Expense Amount$ Expense Description Vendor/Store Name for Expense
#6	$Expense Amount$ Expense Description Vendor/Store Name for Expense
#7	$Expense Amount$ Expense Description Vendor/Store Name for Expense
#8	$Expense Amount$ Expense Description Vendor/Store Name for Expense
#9	$Expense Amount$ Expense Description Vendor/Store Name for Expense

RECEIPT UPLOAD

UPLOAD ALL YOUR RECEIPTS

Your reimbursement will not be dispersed until ALL RECEIPTS are submited electronically or physically dropped off in the school office in the PTA REIMBURSMENT basket. NOTE*CHECK MAY BE DELAYED IF receipts are dropped off and not uploaded**

Receipt or Invoice Submitted?*

Reason for not including receipt or invoice:

Please note: If an invoice or receipt is not submitted, reimbursement will be delayed until all items are verified.

Notes

COMMITTEE CHAIR SIGNATURE

All Committee Chairs must sign Reimbursement forms

For Treasurer's Use

Amount:

Date Check Issued:

Check Number:

Approved By:

Date Approved:

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Weaver Elementary PTA Reimbursement or Check Request Form

Reimbursement Information

For Treasurer's Use

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